Jump to content
Support our work - please give today

Ruhe, 2019 Comment on Horowitz, 2019 Tapering of SSRI treatment to mitigate withdrawal symptoms

Onmyway

By Onmyway
in From journals and scientific sources

 Share

Recommended Posts

  • Moderator
Onmyway Veteran

Onmyway

Posted
  • Moderator
Posted

https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(19)30182-8/fulltext

 

This just came out as a response to the Horrowitz paper. It is proposing a much more aggressive path to discontinuation than the 10%  rule and has tapering schedules for a number of drugs. Seems like they call their version mini tapering and the 10% reduction micro-tapering. They also seem to be against long holds between tapering. 

 

"This Taskforce does not consider prolonged use of any dosage of these discontinuation steps without further attempts of discontinuation as being rational pharmacotherapy. SNRI=serotonin–norepinephrine reuptake inhibitor."

 

Here is the abstract: 

"In their excellent manuscript, published in The Lancet Psychiatry, Mark Horowitz and David Taylor 1  share their personal view on tapering of SSRI treatment to mitigate antidepressant withdrawal symptoms. In the Netherlands, this topic has been raising debate as well, 2 which urged representatives of the Dutch college of General Practitioners, the Royal Dutch Pharmacists Association, the Dutch Association for Psychiatry, and the patient organisation MIND to develop multidisciplinary recommendations for the discontinuation of SSRIs and serotonin–norepinephrine reuptake inhibitors (SNRIs; appendix pp 1–15). Independent of Horowitz and Taylor,1  but with identical reasoning, we proposed reducing doses of SSRIs or SNRIs hyperbolically, and we also advocated the strategy of mini-tapering (table; appendix pp 3–6)."

 

On a positive note, there seems to be a long term trial of discontinuation of SSRIs in the Netherlands. Details here: https://opera-project.nl/

 

"Nothing so small as a moment is insurmountable, and moments are all that we have. You have survived every trial and tribulation that life has thrown at you up until this very instant. When future troubles come—and they will come—a version of you will be born into that moment that can conquer them, too." - Kevin Koenig 

 

I am not a doctor and this should not be considered medical advice. You can use the information and recommendations provided in whatever way you want and all decisions on your treatment are yours. 

 

In the next few weeks I do not have a lot of capacity to respond to questions. If you need a quick answer pls tag or ask other moderators who may want to be tagged. 

 

Aug  2000 - July 2003 (ct, 4-6 wk wd) , citalopram 20 mg,  xanax prn, wellbutrin for a few months, trazodone prn 

Dec 2004 - July 2018 citalopram 20 mg, xanax prn (rarely used)

Aug 2018 - citalopram 40 mg (self titrated up)

September 2018 - January 2019 tapered citalopram - 40/30/20/10/5 no issues until a week after reaching 0

Feb 2019 0.25 xanax - 0.5/day (3 weeks) over to klonopin 0.25 once a day to manage severe wd

March 6, reinstated citalopram 2.5 mg (liquid), klonopin 0.25 mg for sleep 2-3 times a week

Apr 1st citalopram 2.0 mg (liquid), klonopin 0.25 once a week (off by 4/14/19- no tapering)

citalopram (liquid) 4/14/19 -1.8 mg, 5/8/19 - 1.6 mg,  7/27/19 -1.5 mg,  8/15/19 - 1.35, 2/21/21 - 1.1 (smaller drops in between), 6/20/21 - 1.03 mg, 8/7/21- 1.025, 8/11/21 - 1.02, 8/15/21 - 1.015, 9/3/21 - 0.925 (fingers crossed!), 10/8/21 - 0.9, 10/18/21 - 0.875, 12/31/21 - 0.85, 1/7/22 - 0.825, 1/14/22 - 0.8, 1/22/22 - 0.785, 8/18/22 - 0.59, 12/15/2022 - 0.48, 2/15/22 - 0.43, 25/07/23 - 0.25 (mistake), 6/08/23 - 0.33mg

 

Supplements: magnesium citrate and bi-glycinate

Link to comment
Share on other sites
kayjaydee Rookie

kayjaydee

Posted
Posted

The details are there......but they're in Dutch!

1991 fluoxetine 20mg; Jan 1994 switch to dosulepin 50mg

Jul 1994 switch to clomipramine 50mg

1994 - 2006 clomipramine, doses varying from 50mg to 125mg and back, no major problems decreasing by 12.5mg at a time.

2007 clomipramine 75mg to 0 in 3 weeks, then citalopram 20mg

Jul 2007 switch to dosulepin 50-75mg. Jan 2008 switch to clomipramine 50mg.

2008 to present, clomipramine; to 100mg 2011 following my mother's death

2013 back to 50mg in steps of 12.5mg. 2018 still 50mg, but thinking of reducing - have been OK at 37.5 in the past.

Jan 2019 reduced to 44mg. Feb 2019 to 40mg. Mid-March 2019 to 35mg. July 2019 to 32.5mg. Mid August to 30mg.

Late Sept to 27.5mg. Late Oct. to 25mg. Late May 2020 to 22.5mg. Late June to 20.5mg. Early Aug to 18.4mg. Mid Sept to 19.1mg. October to 20mg, Nov 22.5, Dec 25mg. Stayed on that till October 2022, then to 33 mg, Nov 4th to 41, Nov 11 back to 33, Nov 22 to 29mg, 25 Nov back to 33mg. Dec 2022 to 25mg, Jan 2023 to 22mg, Feb 2023 to 20mg, May 2023 to 18mg, Sept 2023 to 16.2mg. Dec 2023 to 14.6mg. Discontinued 29th Dec on orders of cardiologist. Sertraline 25mg for 4 days Feb 2024, stopped but then restarted at 50mg on 15th Feb....to 100mg for one day 23rd Feb, felt awful. Stopped it on 28th Feb. Started mirtazapine 15mg on 5th Mar.

 

Link to comment
Share on other sites
  • Moderator
Onmyway Veteran

Onmyway

Posted
  • Author
  • Moderator
Posted
1 minute ago, kayjaydee said:

The details are there......but they're in Dutch!

Google translate was decent (it gave me the option on the page as I opened!) 

 

"Nothing so small as a moment is insurmountable, and moments are all that we have. You have survived every trial and tribulation that life has thrown at you up until this very instant. When future troubles come—and they will come—a version of you will be born into that moment that can conquer them, too." - Kevin Koenig 

 

I am not a doctor and this should not be considered medical advice. You can use the information and recommendations provided in whatever way you want and all decisions on your treatment are yours. 

 

In the next few weeks I do not have a lot of capacity to respond to questions. If you need a quick answer pls tag or ask other moderators who may want to be tagged. 

 

Aug  2000 - July 2003 (ct, 4-6 wk wd) , citalopram 20 mg,  xanax prn, wellbutrin for a few months, trazodone prn 

Dec 2004 - July 2018 citalopram 20 mg, xanax prn (rarely used)

Aug 2018 - citalopram 40 mg (self titrated up)

September 2018 - January 2019 tapered citalopram - 40/30/20/10/5 no issues until a week after reaching 0

Feb 2019 0.25 xanax - 0.5/day (3 weeks) over to klonopin 0.25 once a day to manage severe wd

March 6, reinstated citalopram 2.5 mg (liquid), klonopin 0.25 mg for sleep 2-3 times a week

Apr 1st citalopram 2.0 mg (liquid), klonopin 0.25 once a week (off by 4/14/19- no tapering)

citalopram (liquid) 4/14/19 -1.8 mg, 5/8/19 - 1.6 mg,  7/27/19 -1.5 mg,  8/15/19 - 1.35, 2/21/21 - 1.1 (smaller drops in between), 6/20/21 - 1.03 mg, 8/7/21- 1.025, 8/11/21 - 1.02, 8/15/21 - 1.015, 9/3/21 - 0.925 (fingers crossed!), 10/8/21 - 0.9, 10/18/21 - 0.875, 12/31/21 - 0.85, 1/7/22 - 0.825, 1/14/22 - 0.8, 1/22/22 - 0.785, 8/18/22 - 0.59, 12/15/2022 - 0.48, 2/15/22 - 0.43, 25/07/23 - 0.25 (mistake), 6/08/23 - 0.33mg

 

Supplements: magnesium citrate and bi-glycinate

Link to comment
Share on other sites
kayjaydee Rookie

kayjaydee

Posted
Posted

I'm failing to find the translation....but never mind, it was only an idle thought to see what it said rather than rely on summaries. I plan to continue with 10% reduction anyway.

1991 fluoxetine 20mg; Jan 1994 switch to dosulepin 50mg

Jul 1994 switch to clomipramine 50mg

1994 - 2006 clomipramine, doses varying from 50mg to 125mg and back, no major problems decreasing by 12.5mg at a time.

2007 clomipramine 75mg to 0 in 3 weeks, then citalopram 20mg

Jul 2007 switch to dosulepin 50-75mg. Jan 2008 switch to clomipramine 50mg.

2008 to present, clomipramine; to 100mg 2011 following my mother's death

2013 back to 50mg in steps of 12.5mg. 2018 still 50mg, but thinking of reducing - have been OK at 37.5 in the past.

Jan 2019 reduced to 44mg. Feb 2019 to 40mg. Mid-March 2019 to 35mg. July 2019 to 32.5mg. Mid August to 30mg.

Late Sept to 27.5mg. Late Oct. to 25mg. Late May 2020 to 22.5mg. Late June to 20.5mg. Early Aug to 18.4mg. Mid Sept to 19.1mg. October to 20mg, Nov 22.5, Dec 25mg. Stayed on that till October 2022, then to 33 mg, Nov 4th to 41, Nov 11 back to 33, Nov 22 to 29mg, 25 Nov back to 33mg. Dec 2022 to 25mg, Jan 2023 to 22mg, Feb 2023 to 20mg, May 2023 to 18mg, Sept 2023 to 16.2mg. Dec 2023 to 14.6mg. Discontinued 29th Dec on orders of cardiologist. Sertraline 25mg for 4 days Feb 2024, stopped but then restarted at 50mg on 15th Feb....to 100mg for one day 23rd Feb, felt awful. Stopped it on 28th Feb. Started mirtazapine 15mg on 5th Mar.

 

Link to comment
Share on other sites
  • Moderator
Onmyway Veteran

Onmyway

Posted
  • Author
  • Moderator
Posted

Hi Kayjaydee, I think I misunderstood.

The article itself is in English and the full text is available incl. their proposed tapering schedules. It's just a letter. The Dutch study description is in Dutch but there are no results from it yet, it just talks about the task force and the study design. I think the study will be 2 years+.  This is with Google Translate: 

https://opera-project.nl/

Target

With the OPERA study we want to get more clarity about the reduction of antidepressants. The central question is: does it matter whether you stop taking antidepressants sooner or later after recovery from depression?

Study design

Approximately 2,000 people with depression who have recently started taking antidepressants identify who is recovering. Four hundred recovered patients will be phasing out their antidepressants within a one-year period. Participants are randomly divided into two groups by means of a draw: the early or the later finishing group. After the withdrawal period, the antidepressants are replaced by a placebo pill. Both the doctor and the patient do not know at what time the reduction will start. During and after dismantling, a check is made to see whether symptoms remain away, and how it is going to affect the quality of life, the functioning and the severity of psychological and physical symptoms (side effects, withdrawal symptoms). These outcome measures are (largely online) measured at 10 moments during 2 years after the draw.

Performance

This national research is carried out at general practice and mental healthcare institutions from a consortium of university medical centers throughout the Netherlands (Amsterdam UMC, UMCG, Radboud UMC, Erasmus MC, LUMC). It is also supported by patient organizations and professional organizations (Depression Association, NHG, NVvP, NEDKAD, KNMP, NIVEL). The knowledge and the results of this study about phasing out with antidepressants can be applied in practice.

Read here  the press release about the OPERA project. For more information you can contact the project coordinators Dr. Karlijn Joling (k.joling@vumc.nl) or Dr. Mariska Bot (m.bot@vumc.nl).

 

 

 

"Nothing so small as a moment is insurmountable, and moments are all that we have. You have survived every trial and tribulation that life has thrown at you up until this very instant. When future troubles come—and they will come—a version of you will be born into that moment that can conquer them, too." - Kevin Koenig 

 

I am not a doctor and this should not be considered medical advice. You can use the information and recommendations provided in whatever way you want and all decisions on your treatment are yours. 

 

In the next few weeks I do not have a lot of capacity to respond to questions. If you need a quick answer pls tag or ask other moderators who may want to be tagged. 

 

Aug  2000 - July 2003 (ct, 4-6 wk wd) , citalopram 20 mg,  xanax prn, wellbutrin for a few months, trazodone prn 

Dec 2004 - July 2018 citalopram 20 mg, xanax prn (rarely used)

Aug 2018 - citalopram 40 mg (self titrated up)

September 2018 - January 2019 tapered citalopram - 40/30/20/10/5 no issues until a week after reaching 0

Feb 2019 0.25 xanax - 0.5/day (3 weeks) over to klonopin 0.25 once a day to manage severe wd

March 6, reinstated citalopram 2.5 mg (liquid), klonopin 0.25 mg for sleep 2-3 times a week

Apr 1st citalopram 2.0 mg (liquid), klonopin 0.25 once a week (off by 4/14/19- no tapering)

citalopram (liquid) 4/14/19 -1.8 mg, 5/8/19 - 1.6 mg,  7/27/19 -1.5 mg,  8/15/19 - 1.35, 2/21/21 - 1.1 (smaller drops in between), 6/20/21 - 1.03 mg, 8/7/21- 1.025, 8/11/21 - 1.02, 8/15/21 - 1.015, 9/3/21 - 0.925 (fingers crossed!), 10/8/21 - 0.9, 10/18/21 - 0.875, 12/31/21 - 0.85, 1/7/22 - 0.825, 1/14/22 - 0.8, 1/22/22 - 0.785, 8/18/22 - 0.59, 12/15/2022 - 0.48, 2/15/22 - 0.43, 25/07/23 - 0.25 (mistake), 6/08/23 - 0.33mg

 

Supplements: magnesium citrate and bi-glycinate

Link to comment
Share on other sites
kayjaydee Rookie

kayjaydee

Posted
Posted

Interesting that they're doing the study double-blind - that would reduce effects like worrying about feeling worse because you know you're on a lower dose.

1991 fluoxetine 20mg; Jan 1994 switch to dosulepin 50mg

Jul 1994 switch to clomipramine 50mg

1994 - 2006 clomipramine, doses varying from 50mg to 125mg and back, no major problems decreasing by 12.5mg at a time.

2007 clomipramine 75mg to 0 in 3 weeks, then citalopram 20mg

Jul 2007 switch to dosulepin 50-75mg. Jan 2008 switch to clomipramine 50mg.

2008 to present, clomipramine; to 100mg 2011 following my mother's death

2013 back to 50mg in steps of 12.5mg. 2018 still 50mg, but thinking of reducing - have been OK at 37.5 in the past.

Jan 2019 reduced to 44mg. Feb 2019 to 40mg. Mid-March 2019 to 35mg. July 2019 to 32.5mg. Mid August to 30mg.

Late Sept to 27.5mg. Late Oct. to 25mg. Late May 2020 to 22.5mg. Late June to 20.5mg. Early Aug to 18.4mg. Mid Sept to 19.1mg. October to 20mg, Nov 22.5, Dec 25mg. Stayed on that till October 2022, then to 33 mg, Nov 4th to 41, Nov 11 back to 33, Nov 22 to 29mg, 25 Nov back to 33mg. Dec 2022 to 25mg, Jan 2023 to 22mg, Feb 2023 to 20mg, May 2023 to 18mg, Sept 2023 to 16.2mg. Dec 2023 to 14.6mg. Discontinued 29th Dec on orders of cardiologist. Sertraline 25mg for 4 days Feb 2024, stopped but then restarted at 50mg on 15th Feb....to 100mg for one day 23rd Feb, felt awful. Stopped it on 28th Feb. Started mirtazapine 15mg on 5th Mar.

 

Link to comment
Share on other sites
  • Altostrata changed the title to Ruhe, 2019 Comment on Horowitz, 2019 Tapering of SSRI treatment to mitigate withdrawal symptoms
  • Administrator
Altostrata Grand Master

Altostrata

Posted
  • Administrator
Posted

Please read this before starting any more topics in Journals

 

A page in English about the OPERA study https://psychiatryamsterdam.nl/project/opera/

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

Link to comment
Share on other sites
kayjaydee Rookie

kayjaydee

Posted
Posted

Thanks, Altostrata, I'll check that out.

1991 fluoxetine 20mg; Jan 1994 switch to dosulepin 50mg

Jul 1994 switch to clomipramine 50mg

1994 - 2006 clomipramine, doses varying from 50mg to 125mg and back, no major problems decreasing by 12.5mg at a time.

2007 clomipramine 75mg to 0 in 3 weeks, then citalopram 20mg

Jul 2007 switch to dosulepin 50-75mg. Jan 2008 switch to clomipramine 50mg.

2008 to present, clomipramine; to 100mg 2011 following my mother's death

2013 back to 50mg in steps of 12.5mg. 2018 still 50mg, but thinking of reducing - have been OK at 37.5 in the past.

Jan 2019 reduced to 44mg. Feb 2019 to 40mg. Mid-March 2019 to 35mg. July 2019 to 32.5mg. Mid August to 30mg.

Late Sept to 27.5mg. Late Oct. to 25mg. Late May 2020 to 22.5mg. Late June to 20.5mg. Early Aug to 18.4mg. Mid Sept to 19.1mg. October to 20mg, Nov 22.5, Dec 25mg. Stayed on that till October 2022, then to 33 mg, Nov 4th to 41, Nov 11 back to 33, Nov 22 to 29mg, 25 Nov back to 33mg. Dec 2022 to 25mg, Jan 2023 to 22mg, Feb 2023 to 20mg, May 2023 to 18mg, Sept 2023 to 16.2mg. Dec 2023 to 14.6mg. Discontinued 29th Dec on orders of cardiologist. Sertraline 25mg for 4 days Feb 2024, stopped but then restarted at 50mg on 15th Feb....to 100mg for one day 23rd Feb, felt awful. Stopped it on 28th Feb. Started mirtazapine 15mg on 5th Mar.

 

Link to comment
Share on other sites
 Share
Go to topic listing
×
×
  • Create New...

Important Information

Terms of Use Privacy Policy

  I accept